Zygomatic Arch Resection – Procedure, Indications and Recovery

What Is a Zygomatic Arch Resection?

Zygomatic arch resection is a surgical procedure performed in the fields of oral and maxillofacial surgery and neurosurgery, in which the zygomatic arch (Latin: Arcus zygomaticus) is partially or completely removed. The zygomatic arch is a bony bridge on the lateral aspect of the face that connects the zygomatic bone to the temporal bone, forming an important structural landmark of the facial skeleton. The resection may be performed as a standalone procedure or as part of a more complex operation to improve surgical access to deeper anatomical regions such as the middle cranial fossa or the infratemporal fossa.

Indications

A zygomatic arch resection is performed for several medical reasons:

• Tumor removal: Benign or malignant tumors infiltrating the zygomatic arch or adjacent structures often require resection of the affected bone.
• Neurosurgical access: In skull base surgeries, particularly those involving the middle cranial fossa, the zygomatic arch is temporarily or permanently removed to achieve a wider operative field.
• Traumatic fractures: Severely displaced or non-healing zygomatic arch fractures may require partial resection and subsequent reconstruction.
• Trismus: Significant scarring or bony ankylosis causing permanent restriction of mouth opening may be treated by resection to improve mandibular mobility.

Surgical Procedure

The procedure is performed under general anesthesia by an experienced oral and maxillofacial or neurosurgeon. Access to the zygomatic arch is typically gained through a preauricular incision or a coronal incision along the hairline. Once the arch is exposed, the bone is divided using surgical saws or osteotomes and carefully removed.

Temporary versus Permanent Resection

In neurosurgical approaches, the zygomatic arch is often removed only temporarily and reattached at the end of the procedure using titanium plates and screws (referred to as a zygomatic arch osteotomy). In cases involving tumors or severe bone destruction, a permanent resection is necessary, which may subsequently require reconstructive measures.

Reconstruction After Zygomatic Arch Resection

Following permanent resection, the zygomatic arch can be reconstructed using several approaches:

• Autologous bone grafts: Use of the patient's own bone, for example from the iliac crest or calvarial bone.
• Alloplastic implants: Titanium plates or custom-made CAD/CAM implants fabricated from titanium or porous polyethylene (e.g., Medpor).
• Free flaps: In cases of extensive tissue defects, microsurgical tissue transfer may be required.

Risks and Possible Complications

As with any surgical procedure, there are potential risks and complications:

• Injury to the facial nerve (nervus facialis) leading to facial palsy
• Intraoperative or postoperative bleeding
• Surgical site infection
• Swelling and hematoma formation
• Facial asymmetry
• Sensory disturbances in the distribution area of the zygomatic nerve
• Implant failure or displacement in reconstructed cases

Aftercare and Recovery

Close postoperative follow-up is essential after this procedure. Swelling and pain around the surgical site are expected in the first few days. Physiotherapy may be recommended to rehabilitate jaw opening and the masticatory muscles. Imaging controls using CT or MRI are routinely performed to assess surgical outcomes and for oncological follow-up. Full recovery may take several weeks to months depending on the extent of the procedure.

References

1. Prein, J. et al. - Manual of Internal Fixation in the Cranio-Facial Skeleton. Springer Verlag, 2nd edition.
2. Schmelzeisen, R. et al. - Oral and Maxillofacial Surgery. Elsevier, Urban and Fischer Verlag.
3. Al-Mefty, O. - Operative Atlas of Meningiomas. Lippincott-Raven, 1998.